[31F] With multiple systemic symptoms including fatigue, hot flashes, and swelling

Patient Description

A 31-year-old female presents with a constellation of symptoms including extreme fatigue, sudden and intense hot flashes, excessive sweating, and leg swelling with discoloration. The fatigue is particularly severe after work and can last for up to two days. The hot flashes and sweating occur throughout the day and sometimes at night. She also reports occasional nausea, which is relieved by sitting down, using an ice pack, laying down, or taking Zofran. The patient has experienced unexplained weight loss of about 10 lbs over the past two months due to a significant decrease in appetite. She also reports unusual vaginal bleeding, which is random and varies in color from bright red to dark brown. She has been on Nexplanon and did not have a period for five years before this started a few months ago. Additionally, she has had a red, bumpy, and painful rash on her arm for the past three weeks and a similar rash on her butt cheek a few months ago that lasted about a month. The patient also reports lower back pain, which is achy and deep, and leg pain that is aching and throbbing, rated as 8 most days. She has experienced night sweats and itching, along with a slight fever sometimes, never over 100°. She has a swollen lymph node in her left armpit and swollen lymph nodes at the bend of her arms. She also reports bleeding gums and occasional unexplained bruising. The patient has developed very dark circles around her eyes with a yellow tint for about a month and a half. She has been diagnosed with bipolar disorder since she was 18 and interstitial cystitis a few months ago. She is currently taking Lamictal (75mg once daily) and amitriptyline (0.25mg once daily for interstitial cystitis). She also reports low blood pressure recently. Her medical history includes E. coli in the urinary tract as a child, two C-sections, and arm surgery. She works at a car repair shop, which involves being in the sun and walking a lot.

Arora's Assessment

What might be happening

It is likely that your symptoms are related to multiple issues, including existing diagnoses. If you have more questions, we can continue chatting.

Causes of your extreme fatigue, night sweats, and hot flashes:

Hormonal Imbalances: Conditions like hyperthyroidism or early menopause can cause extreme fatigue, night sweats, and hot flashes. Hormonal changes can also lead to other symptoms like weight loss and changes in appetite.
Infections or Inflammatory Conditions: Chronic infections or inflammatory conditions can cause fatigue, night sweats, and systemic symptoms like rashes and swollen lymph nodes.

Causes of your leg swelling, pain, and discoloration:

Chronic Venous Insufficiency: This condition can cause fluid retention, leg swelling, and pain, especially after standing for long periods. It can also lead to skin discoloration.
Heart or Kidney Issues: Given the fluid retention and swelling, it’s important to rule out heart or kidney problems, which can cause similar symptoms.

Causes of your unusual vaginal bleeding:

Hormonal Imbalances: Since you are on Nexplanon, hormonal fluctuations could be causing irregular bleeding.
Gynecological Issues: Conditions like polycystic ovary syndrome (PCOS) or endometrial issues can cause irregular bleeding.

Causes of your rashes and itching:

Dermatitis or Allergic Reactions: Red, bumpy, and itchy rashes can be due to dermatitis or allergic reactions.
Infections: Skin infections can also present with similar symptoms.

Causes of your nausea and appetite changes:

Gastrointestinal Issues: Conditions like gastritis or gastroesophageal reflux disease (GERD) can cause nausea and changes in appetite.
Systemic Illnesses: Chronic illnesses can affect your appetite and cause nausea.

Causes of your dark circles and facial flushing:

Fatigue and Stress: Chronic fatigue and stress can lead to dark circles under the eyes.
Rosacea or Other Skin Conditions: Facial flushing can be a symptom of rosacea or other skin conditions.

Unifying Diagnoses:

Autoimmune Disorders: Conditions like lupus or rheumatoid arthritis can cause a wide range of symptoms, including fatigue, rashes, joint pain, and systemic issues.
Chronic Infections: Chronic infections like tuberculosis or Lyme disease can cause systemic symptoms, including fatigue, night sweats, and swollen lymph nodes.

What you can do

Fatigue, night sweats, and hot flashes:

See a doctor as soon as possible: These symptoms are concerning and need to be evaluated by a healthcare professional. Your doctor may order blood tests, hormone level tests, and imaging studies.
Stay hydrated: Drink plenty of water to help manage sweating and hot flashes.
Keep a symptom journal: Use MDandMe to track your symptoms, which can help your doctor identify patterns and potential triggers.

Leg swelling, pain, and discoloration:

Elevate your legs: Elevate your legs when sitting or lying down to reduce swelling.
Wear compression stockings: These can help manage swelling and improve circulation.
Consult your doctor: Your doctor may recommend further tests to evaluate your heart and kidney function.

Unusual vaginal bleeding:

Monitor your bleeding: Keep track of your bleeding episodes, including frequency, duration, and intensity.
Consult your gynecologist: Your doctor may need to adjust your Nexplanon or investigate other potential causes of irregular bleeding.

Rashes and itching:

Avoid irritants: Identify and avoid potential irritants that may be causing your rashes.
Use over-the-counter creams: Anti-itch creams or hydrocortisone can help manage symptoms.
Consult a dermatologist: If the rashes persist, a dermatologist can provide a more specific diagnosis and treatment plan.

Nausea and appetite changes:

Eat small, frequent meals: This can help manage nausea and improve your appetite.
Avoid trigger foods: Identify and avoid foods that worsen your symptoms.
Consult your doctor: Your doctor may recommend medications to manage nausea and investigate underlying causes.

Dark circles and facial flushing:

Get adequate rest: Ensure you are getting enough sleep to help reduce dark circles.
Use gentle skincare products: Avoid harsh products that may irritate your skin.
Consult a dermatologist: A dermatologist can provide treatments for facial flushing and dark circles.

What you should look out for

Given the severity of your symptoms and the possibility of life-threatening causes, you should seek medical care as soon as you can. Reasons to seek care even more urgently include:

Severe or worsening symptoms: If your symptoms